There are wide global variations in the prevalence of caesarean section in developed, developing and underdeveloped countries. The objective of this this study was to determine the trends in caesarean section at Calabar General Hospital, Cross River State. This paper used a retrospective review of clinical records at the maternity units of Calabar General Hospital from 2009 to 2013. Findings from this study showed that Cesarean section rate ranged from 3.85% in 2009 to 7.38% in 2013 with an average cesarean section rate of 5.39%. Based on available data, elective cesarean section progressed substantially from 17.2% in 2009 and slightly declined to 15.3% in 2010, then increased again from 22.5% in 2011, 29.6% in 2012 to 31.0% in 2013. Emergency cesarean section on the other hand increased progressively from 82.8% in 2009 to 84.7% in 2010 then declined from 77.5% in 2011, 70.4% in 2012 to 69.0% in 2013. In conclusion improvement of obstetric services should be a priority in all health care settings.